Clinical Research of Goal-Directed Fluid Therapy with CI,ITBVI and EVLWI in Geriatric Patients Undergoing Major Opera-tion

doi:10.3969/j.issn.1004-5775.2015.06.005

Abstract：Objective To evaluate the influence of goal -directed fluid management based on CI ,ITBVI and EVLWI in geriatric pa-tients undergoing major operation .Methods 40 patients (ASA 3~4) undergoing major operation were included and randomly divided into two groups:goal-directed fluid therapy treatment with CI, ITBVI and EVLWI(group S)and conventional fluid therapy(group R).The routine group was given CVP monitoring rehydration ,and the study group was given PICCO hemodynamic monitoring indicators .CVP, CI, ITBVI and EVLWI for fluid management were measured; accurate assessment of volume status of patients was done .The study group re-ceived goal-directed fluid therapy based on CVP , CI, ITBVI and EVLWI, with the goal of CI in the 3.0~5.0 L/min/m2 range,ITBVI in the 800~1000 mL/m2 range and EVLWI in the 3.0~7.0 mL/kg range.Heart rate (HR), mean arterial pressure (MAP), urine volume, central venous oxygen saturation (ScvO2), lactic acid, renal function and so on were monitored.Postoperative shock improvement and vent-ilator withdrawal time , as well as the incidence of acute pulmonary edema , acute renal failure incidence , mortality between the two groups were observed and compared .Results Tissue perfusion and shock of the study group were significantly improved than that of control group,and urine volume increased (P<0.05).ScvO2 of the study group were higher than that of the routine group (P<0.05).The con-centration of lactic acid of the study group was lower than that of the routine group (P<0.05).The incidence of acute pulmonary edema , acute renal insufficiency and mortality of the study group were lower than that of the routine group (P<0.05).Conclusion Goal-direct-ed fluid therapy based on CI , ITBVI and EVLWI optimizes the cardiac preload effectively in geriatric patients undergoing major operation , improves cardiac output , guarantees the perfusion of microcirculation as well as maintaines the oxygen delivery -consumption balance , re-duces complications , and reduces the mortality rate .